Introduction: Medial patellofemoral ligament reconstruction (MPFLR) is used in most patellar instability surgeries, there is controversy on adding a tibial tuberosity osteotomy (TTO). Objective: To describe the results of isolated MPFLR in patellar instability according to the Tibial Tuberosity-Trochlear Groove distance (TT-TG). Methods: Retrospective study of patients with patellar instability with a mature skeleton in one center between 2016 and 2021, using isolated MPFLR. Patients with incomplete clinical and/or radiological records and less than one year follow-up were excluded. Pre-surgical demographic and radiological data (TT-TG, Caton-Deschamps (CD) index, patellar tilt, trochlear dysplasia) were recorded. Patients were divided into three groups according to TT-TG distance (Group 1: < 17 mm, Group 2: 17–19, Group 3: ≥ 20 mm). A pre and post-surgical Kujala score was performed. Local complications, satisfaction, recurrence and/or reintervention were recorded. Pre-surgical variables between groups, intra and inter-group Kujala differences were compared using Bartlett’s test. Consent from the patients and approval from the local ethics committee were obtained. Results: 67 patients met the selection criteria, mean age of 23 years, 70% were women. There were no pre surgical, radiological nor follow-up differences between the groups (average 27 months). Pre and post-surgical Kujala score, respectively: Group 1: 37–78, Group 2: 37–78, Group 3: 39–79. All groups had a significant improvement (p < 0.05), there were no significant differences in improvement between groups (p > 0.05). There were three patients with a redislocation episode, all in group 1. One patient had a mobilization under anesthesia due to an arthrofibrosis (Group 2). 97% of all cases reported being satisfied. Conclusion: Isolated MPFLR in patellar instability presents a functional improvement, with a low rate of complications and failure, regardless of the pre surgical TT-TG.